邱勇 付云娟

【摘要】 目的：探討右美托咪定復(fù)合地佐辛對(duì)腹腔鏡膽囊切除患者鎮(zhèn)痛的效果及對(duì)血漿兒茶酚胺（CA）、內(nèi)皮素-1（ET-1）的影響。方法：選取本院2017年3月-2019年3月收治的84例行腹腔鏡膽囊切除患者，按自愿選擇的治療方式分為對(duì)照組和試驗(yàn)組，各42例。試驗(yàn)組進(jìn)入手術(shù)室后靜脈滴注1.0 μg/kg的右美托咪定，10 min后，以0.5 μg/（kg·h）維持至手術(shù)結(jié)束，手術(shù)結(jié)束前30 min，靜脈滴注0.1 mg地佐辛。對(duì)照組只在手術(shù)結(jié)束前30 min，靜脈滴注0.1 mg地佐辛。記錄并比較兩組在入室后（T0）、麻醉誘導(dǎo)后（T1）、插管后（T2）、膽囊分離時(shí)（T3）、手術(shù)結(jié)束（T4）的心率（HR）和平均動(dòng)脈壓（MAP）;比較兩組術(shù)前1 h和術(shù)后1 h血清CA和ET-1水平。比較兩組術(shù)后3、6、9、12、24 h視覺模擬評(píng)分法（visual analogue score，VAS）評(píng)分。結(jié)果：對(duì)照組在T1、T2時(shí)的HR與MAP均低于T0，且均低于試驗(yàn)組（P<0.05）。對(duì)照組T3、T4時(shí)的MAP均低于試驗(yàn)組（P<0.05）。試驗(yàn)組在T1～T4時(shí)的HR和MAP與T0比較，差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。術(shù)后3、6、9、12 h，試驗(yàn)組VAS評(píng)分均明顯低于對(duì)照組（P<0.05）。術(shù)后24 h，兩組VAS評(píng)分比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。術(shù)前1 h，兩組血清CA和ET-1水平比較，差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。術(shù)后1 h，試驗(yàn)組血清CA和ET-1水平均明顯低于對(duì)照組（P<0.05）。結(jié)論：右美托咪定復(fù)合地佐辛對(duì)腹腔鏡膽囊切除患者鎮(zhèn)靜鎮(zhèn)痛效果良好，能夠維持循環(huán)系統(tǒng)和血流動(dòng)力學(xué)的穩(wěn)定，降低患者疼痛，改善術(shù)后血清CA和ET-1，緩解應(yīng)激反應(yīng)，值得進(jìn)一步應(yīng)用于臨床。

【關(guān)鍵詞】 腹腔鏡膽囊切除 右美托咪定 地佐辛 兒茶酚胺 ET-1

【Abstract】 Objective： To investigate the effect of Dexmedetomidine combined with Dezocine on analgesia in patients undergoing laparoscopic cholecystectomy and its effect on plasma catecholamine （CA） and endothelin-1 （ET-1）. Method： A total of 84 patients undergoing laparoscopic cholecystectomy admitted to our hospital from March 2017 to March 2019 were selected and divided into control group and experimental group according to the treatment method voluntarily selected， 42 cases in each group. The experimental group after entered the operation room， was 1.0 μg/kg of Dexmedetomidine intravenously instilled， after 10 min， maintained at 0.5 μg/（kg·h） until the end of the surgery， at 30 min before the end of the operation， 0.1 mg of Dezocine was intravenously instilled. The control group only at 30 min before the end of the surgery was 0.1 mg of Dezocine intravenously instilled. Heart rate （HR） and mean arterial pressure （MAP） of the two groups were recorded after entered the room （T0）， after induction of anesthesia （T1）， after intubation （T2）， at the time of gallbladder separation （T3）， at the end of surgery （T4）. Serum CA and ET-1 levels were compared at 1 h before and after surgery. Visual analogue score （VAS） scores were compared at 3， 6， 9， 12 and 24 h after surgery in the two groups. Result： The HR and MAP of the control group at T1 and T2 were lower than those at T0， and lower than those of the experimental group （P<0.05）. MAP at T3 and T4 of the control group were lower than those of the experimental group （P<0.05）. HR and MAP of the experimental group at T1-T4 were compared with those at T0， the differences were not statistically significant （P>0.05）. At 3， 6， 9 and 12 h after surgery， the VAS scores of the experimental group were significantly lower than those of the control group （P<0.05）. 24 h after surgery， there were no significant differences in VAS scores between the two groups （P>0.05）.?1 h before surgery， there was no significant difference in serum CA and ET-1 levels between the two groups （P>0.05）. At 1 h after surgery， serum CA and ET-1 levels in the experimental group were significantly lower than those in the control group （P<0.05）. Conclusion： Dexmedetomidine combined with Dezocine has good sedative and analgesic effects in patients undergoing laparoscopic cholecystectomy， it can maintain the stability of circulatory system and hemodynamics， reduce the pain， improve postoperative serum CA and ET-1 and relieve stress response， it is worth further application in the clinic.